ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 50 P292 | DOI: 10.1530/endoabs.50.P292

The burden of arthropathy in acromegaly: results from an observational study

Nikolaos Kyriakakis1,2, Julie Lynch1, Steve M Orme1, Stephen G Gilbey1, Philip Conaghan3 & Robert D Murray1,2

1Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 2Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK; 3Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.

Introduction: Patients with acromegaly are often left with long-term sequelae, among which arthropathy is the most common. Studies have shown impaired quality of life (QoL) in patients with acromegaly, even after long-term remission. Arthropathy is a negative predictive factor of QoL, due to its impact on physical symptoms and functioning.

Patients/Methods: To characterise further the extent of the acromegalic arthopathy, we conducted an observation study on 62 patients with acromegaly. Participants were interviewed individually for the presence, distribution and severity of joint-related symptoms. Additionally, participants’ medical records were reviewed and acromegaly-related data were collected.

Results: 29 male and 33 female patients with acromegaly (mean age 55±13 yrs) were recruited. 83.8% had pituitary surgery, 41.9% had radiotherapy and 85.5% received medical treatment. Mean duration of active disease and disease remission were 14.3±10.0 yrs and 5.5±7.6 yrs respectively. Based on biochemical criteria, 46.8% of patients had active acromegaly during the study, whereas 53.2% were in remission, which was achieved with or without long-term medical treatment.

88.7% of patients reported arthralgia (mean severity score 3.8±2.8 on a 0–10 scale). The most commonly affected joint site was the knee (71%), followed by the small joints of the wrist/hand (51.6%) and the lower spine (45.2%). 79% of patients reported pain in >1 sites. Joint symptoms were bilateral in 83.8% of cases. 56.5% of patients required analgesia for arthralgia; 51.4% of them on a regular basis. 24.2% of patients had previously undergone joint surgery due to arthropathy (mean age of 51.2±13.1 yrs). In 60% of those cases, patients required surgery in >1 joints.

Conclusions: Acromegalic arthropathy is a symmetrical polyarthropathy, affecting both the axial and appendicular skeleton and remains a major cause of morbidity in acromegaly. It may progress to a debilitating pathology, with patients requiring joint replacement at a relatively young age. Joint-related symptoms should be assessed regularly during clinic appointments. Future research should focus on developing strategies for prevention of the acromegalic arthropathy.

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